Claim total
$775.00
base $93.83 · payer covered $625.00
The visit
- Class
- Wellness
- Code
- 162673000
- Reason
- —
- Start
- 1999-01-15
- Stop
- 1999-01-16
The parties
- Patient
- patient Otis Jed Price
- Provider
- provider Ramiro Boehm
- Payer
- payer Medicaid
Record id
1d8b9eda-b86e-378b-02aa-5497dc986a08